You need medical insurance, if only to protect against the cost of an accident or illness so expensive that you could be ruined financially. But do you really need dental insurance?
It’s an interesting question, because you can avoid the most likely causes and expenses of dental problems, decay and gum disease by brushing and flossing your teeth diligently. But some teeth are more prone to problems, and when there is a problem, the costs can mount quickly.
The price of insurance
About 64 percent of Americans have dental insurance. Nearly all of them have coverage through work or a group plan like AARP, Medicaid, Tricare (for military families) and the federal Children’s Health Insurance Program, according to Evelyn Ireland, executive director of the National Association of Dental Plans, in an email interview.
Most dental preferred provider organization and regular insurance (indemnity) plans have an average deductible of $50 and a maximum yearly benefit of $1,000, Ireland says. Only 2 to 4 percent of Americans with dental insurance use up their yearly maximum allowance.
Dental plans offered through a workplace typically are one of three types:
- Indemnity plan: You choose your provider of choice, and your plan pays a percentage of the fees.
- PPO: Preferred provider organization plans have groups of practitioners who agree to reduced fees for patients within the network. Your costs are lower with network dentists. You may see out-of-network dentists, but it’ll cost you more.
- HMO: Health maintenance organizations cut costs by requiring members to use only providers within the network.
Premiums for group dental plans in 2014 (the latest information available) averaged from $19 to $32 a month ($228 to $384 annually), says the NADP.
Is insurance worth it?
The NADP describes these elements of coverage in a typical plan:
- Preventive care: periodic exams, X-rays and, for some age groups, sealants — 100 percent.
- Basic procedures: office visits, extractions, fillings, root canals (sometimes) and periodontal treatment — 70-80 percent.
- Major procedures: crowns, bridges, inlays, dentures and sometimes implants and root canals — 50 percent or less.
Orthodontics coverage usually can be purchased as a rider, says the NADP. Cosmetic care is not covered.
Dental insurance is not always worth the cost. It depends on your plan, your needs and the cost of the services available to you.
In deciding if an insurance plan is right for you, weigh:
- The annual price of premiums.
- The cost of the dental care you need.
- Your policy’s limit on how much it pays out in benefits and whether you can roll over unused benefits from the previous year.
- Policy coverage.
“While many dental policies focus on preventive measures by offering two annual visits, you’ll really start seeing the savings with more expensive treatments, like root canals and crowns,” explains Angie’s List.
Help from the Affordable Care Act
The Affordable Care Act requires insurance providers to offer dental insurance for children younger than 18.
“Although the new act does not require dental coverage for adults, most state marketplaces will also offer dental coverage for adults,” says the American Dental Association. Adult dental coverage may be offered as part of a comprehensive health plan or as stand-alone dental insurance. Here’s more about the ACA and dental coverage:
- The ADA tells how to compare and assess dental plans.
- Use this Healthcare.gov plan locator to find Affordable Care Act dental plans locally and compare costs.
Dental insurance isn’t the only way to cut dental bills. In fact, 36 percent of Americans have no dental insurance. Here are 10 other ways to cut your costs:
It may be less expensive to pay out of pocket than buy a plan. Fees vary by dentist’s office and by geographic region. Here are average costs in the United States for several common procedures, from the ADA Health Policy Institute’s 2013 Survey of Dental Fees (the latest data available):
- Teeth cleaning (prophylaxis) adult: $85
- White dental filling (one surface, anterior): $149
- Silver filling (one surface, primary or permanent): $125
- Porcelain crown fused to noble metal: $1,003
- Complete series of intra-oral X-rays: $124
2. Preventive care
In many cases, the best way to save on dentistry is to take excellent care of your teeth and gums and to teach children healthy dental routines. For example, did you know that fruit juices, carbonated drinks and acidic foods can help wear away your tooth enamel?
Delta Dental, an insurer, has more tips on preventive care.